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Direct Antibiotic Delivery of Cefazolin Into Soft Tissue Infections Using Subcutaneous Injection and Ultrasonic Dispersion (DAD)

Primary Purpose

Infection, Soft Tissue, Infection, Wound, Cellulitis

Status
No longer available
Phase
Locations
United States
Study Type
Expanded Access
Intervention
Cefazolin
Silberg Tissue Preparation System
Sponsored by
Sonescence, Inc.
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an expanded access trial for Infection, Soft Tissue focused on measuring soft tissue infection, wound infection, cellulitis, foot ulcer, Diabetes, antibiotics, cefazolin, cephazolin, Ancef, Kefzol, subcutaneous fluid administration, ultrasound, MRSA, Methicillin-resistant Staphylococcus aureus

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Subjects with pathologically confirmed presence of serious or immediately life-threatening soft tissue infection, cellulitis or open wound caused by bacteria for which cefazolin at this concentration is likely to have activity to inhibit the bacteria, for example, Staphylococcus species or Streptococcus species, Escherichia coli, Proteus mirabilis.
  • Wounds must demonstrate the presence of skin and skin structure infection, which may be demonstrated by one or more of the following: Culture results as aforementioned, swelling of the tissues, discoloration, open wounds, and/or drainage, which may or may not be associated with pain and/or tenderness.
  • Confirmed presence of soft tissue cellulitis caused by bacteria for which cefazolin is likely to have activity to inhibit the bacteria will be evidenced by microbiologic cultures taken no greater than ten (10) days prior to treatment.
  • Subject must have previously been treated by a qualified licensed physician using traditional surgical and/or medical treatments, which may include courses of IV antibiotics, but where Subject was unable to resolve their infection through traditional surgical and/or medical treatments for soft tissue cellulitis caused by bacteria for which cefazolin is likely to have activity to inhibit the bacteria at a maximum concentration of 1 gram per 100 ml saline, as demonstrated by the presence of induration, redness, open wounds, and/or soft tissue swelling.
  • Subject must be referred by his or her treating physician to the Wound Care Center of the investigational hospital.
  • The Wound Care Center of the investigational hospital has confirmed that standard therapies have failed to cure the subject's infection and the infection is still present.
  • Subjects are not on concomitant antibacterial drugs since these drugs have failed to treat the subject's infection.
  • Subject may be male or female and must be at least 18 years of age.
  • Subject must sign informed consent as approved by the Institutional Review Board (IRB).

Exclusion Criteria:

  • Subjects who have not received treatment by traditional surgical and/or medical therapies.
  • Subjects who are allergic to cefazolin.
  • Subjects who have a serious allergy to penicillin.
  • Subjects with infections that involve body cavities.
  • Subjects designated to be vulnerable, i.e., pregnant women, subjects under the age of 18, and subjects who need to have consent provided by a Legally Authorized Representative (LAR).
  • Subjects who are unable or unwilling to comply with the protocol.
  • Subjects who have a history of clinically significant or uncontrolled cardiac disease, including congestive heart failure, angina, myocardial infarction, arrhythmia, including New York Heart Association (NYHA) functional classification of 3.
  • Subjects who have any other life-threatening illness or organ system dysfunction, which, in the opinion of the investigator, would either compromise subject safety or interfere with the evaluation of the safety of the test drug.
  • Subjects who cannot understand English.
  • Subjects who have received a treatment under this study are not eligible for re-admittance for thirty (30) days from the date of their last treatment.

Sites / Locations

  • Sonoma West Medical Center

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
November 8, 2010
Last Updated
October 21, 2018
Sponsor
Sonescence, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01238276
Brief Title
Direct Antibiotic Delivery of Cefazolin Into Soft Tissue Infections Using Subcutaneous Injection and Ultrasonic Dispersion
Acronym
DAD
Official Title
Direct Antibiotic Delivery of Cefazolin Into Soft Tissue Infections Using Subcutaneous Injection and Ultrasonic Dispersion
Study Type
Expanded Access

2. Study Status

Record Verification Date
October 2018
Overall Recruitment Status
No longer available
Study Start Date
undefined (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sonescence, Inc.

4. Oversight

5. Study Description

Brief Summary
This study focuses on a new drug delivery system (Direct Antibiotic Delivery) to treat soft tissue infections. In this study, cefazolin is delivered directly to the target tissues using subcutaneous injection of antibiotic solution and then dispersed using high-frequency external ultrasound. Using this system, a much higher concentration of antibiotic can be achieved than through traditional treatment methods. Unlike traditional delivery methods, Direct Antibiotic Delivery does not rely on blood supply and is beneficial for subjects with Diabetes or subjects who have received radiation therapy and blood supply is limited.
Detailed Description
In this study, the DOSAGE of cefazolin that is delivered is a fraction of that which is already FDA approved for intramuscular (IM) administration. However, the CONCENTRATION in the target area is much higher than what can be achieved through intravenous (IV) administration, while still being far less than what is approved for IM administration. Previous to this study, cefazolin was considered to be ineffective in treating Methicillin-resistant Staphylococcus aureus (MRSA) as it had only been tested at the concentrations that were attainable by traditional methods. Through our study and laboratory tests conducted at the Harford Hospital, Connecticut, we have confirmed that cefazolin can be effective against even the most resistant strains of MRSA if a high enough concentration is obtained. Under this study, treatment is only available to subjects that have already undergone standard therapy, but were not able to resolve the infection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Infection, Soft Tissue, Infection, Wound, Cellulitis, Diabetic Foot Ulcer
Keywords
soft tissue infection, wound infection, cellulitis, foot ulcer, Diabetes, antibiotics, cefazolin, cephazolin, Ancef, Kefzol, subcutaneous fluid administration, ultrasound, MRSA, Methicillin-resistant Staphylococcus aureus

7. Study Design

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Cefazolin
Other Intervention Name(s)
Ancef, Kefzol
Intervention Description
Cefazolin is approved for clinical use for some bacterial infections. The standard routes of administration are Intramuscular (IM) and intravenous (IV). For this study, the route of administration will be delivered using the Silberg TPS, which delivers the cefazolin by subcutaneous injection followed by external ultrasonic dispersion. The concentration delivered is one gram/100 ml saline. Cefazolin can safely be given IM at the much higher concentration of 1 gram/2.5 ml of saline. The maximum dose that may be administered is 3 grams in 300 ml, which is within the approved guidelines of a daily dose. The concentration of antibiotic will be the same; only the dose may vary depending on the size of the wound or area of induration. Each subject will receive only one treatment in this study.
Intervention Type
Device
Intervention Name(s)
Silberg Tissue Preparation System
Other Intervention Name(s)
Silberg TPS (K023083), Tissue Preparation System, TPS, Mettler ME800
Intervention Description
The TPS is FDA cleared for the subcutaneous infusion and ultrasonic dispersion of tumescent fluid excluding the parenteral delivery of drugs. Under this study, the TPS is a device to deliver cefazolin by subcutaneous injection followed by external ultrasonic dispersion. The TPS consists of a medical grade peristaltic pump that is used to infuse antibiotic solution using a sterile blunt-tipped infusion cannula into a superficial subcutaneous plane. After the cannula has been removed, high frequency external ultrasound is delivered transcutaneously over the area of infusion in order to disperse the antibiotic solution. The power density is within the range allowed for physical therapy.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Subjects with pathologically confirmed presence of serious or immediately life-threatening soft tissue infection, cellulitis or open wound caused by bacteria for which cefazolin at this concentration is likely to have activity to inhibit the bacteria, for example, Staphylococcus species or Streptococcus species, Escherichia coli, Proteus mirabilis. Wounds must demonstrate the presence of skin and skin structure infection, which may be demonstrated by one or more of the following: Culture results as aforementioned, swelling of the tissues, discoloration, open wounds, and/or drainage, which may or may not be associated with pain and/or tenderness. Confirmed presence of soft tissue cellulitis caused by bacteria for which cefazolin is likely to have activity to inhibit the bacteria will be evidenced by microbiologic cultures taken no greater than ten (10) days prior to treatment. Subject must have previously been treated by a qualified licensed physician using traditional surgical and/or medical treatments, which may include courses of IV antibiotics, but where Subject was unable to resolve their infection through traditional surgical and/or medical treatments for soft tissue cellulitis caused by bacteria for which cefazolin is likely to have activity to inhibit the bacteria at a maximum concentration of 1 gram per 100 ml saline, as demonstrated by the presence of induration, redness, open wounds, and/or soft tissue swelling. Subject must be referred by his or her treating physician to the Wound Care Center of the investigational hospital. The Wound Care Center of the investigational hospital has confirmed that standard therapies have failed to cure the subject's infection and the infection is still present. Subjects are not on concomitant antibacterial drugs since these drugs have failed to treat the subject's infection. Subject may be male or female and must be at least 18 years of age. Subject must sign informed consent as approved by the Institutional Review Board (IRB). Exclusion Criteria: Subjects who have not received treatment by traditional surgical and/or medical therapies. Subjects who are allergic to cefazolin. Subjects who have a serious allergy to penicillin. Subjects with infections that involve body cavities. Subjects designated to be vulnerable, i.e., pregnant women, subjects under the age of 18, and subjects who need to have consent provided by a Legally Authorized Representative (LAR). Subjects who are unable or unwilling to comply with the protocol. Subjects who have a history of clinically significant or uncontrolled cardiac disease, including congestive heart failure, angina, myocardial infarction, arrhythmia, including New York Heart Association (NYHA) functional classification of 3. Subjects who have any other life-threatening illness or organ system dysfunction, which, in the opinion of the investigator, would either compromise subject safety or interfere with the evaluation of the safety of the test drug. Subjects who cannot understand English. Subjects who have received a treatment under this study are not eligible for re-admittance for thirty (30) days from the date of their last treatment.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Barry N Silberg, MD
Organizational Affiliation
Sonoma West Medical Center, Santa Rosa Memorial Hospital, Sutter Health
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
James K Gude, MD
Organizational Affiliation
Sonoma West Medical Center
Official's Role
Study Director
Facility Information:
Facility Name
Sonoma West Medical Center
City
Sebastopol
State/Province
California
ZIP/Postal Code
95472
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
11304356
Citation
Weninger KR, Camara CG, Putterman SJ. Observation of bubble dynamics within luminescent cavitation clouds: Sonoluminescence at the nano-scale. Phys Rev E Stat Nonlin Soft Matter Phys. 2001 Jan;63(1 Pt 2):016310. doi: 10.1103/PhysRevE.63.016310. Epub 2000 Dec 27.
Results Reference
background
PubMed Identifier
17243061
Citation
Lavery LA, Armstrong DG, Murdoch DP, Peters EJ, Lipsky BA. Validation of the Infectious Diseases Society of America's diabetic foot infection classification system. Clin Infect Dis. 2007 Feb 15;44(4):562-5. doi: 10.1086/511036. Epub 2007 Jan 17.
Results Reference
background
PubMed Identifier
10874526
Citation
Frisoli Junior A, de Paula AP, Feldman D, Nasri F. Subcutaneous hydration by hypodermoclysis. A practical and low cost treatment for elderly patients. Drugs Aging. 2000 Apr;16(4):313-9. doi: 10.2165/00002512-200016040-00007.
Results Reference
background
PubMed Identifier
8877023
Citation
Champoux N, Du Souich P, Ravaoarinoro M, Phaneuf D, Latour J, Cusson JR. Single-dose pharmacokinetics of ampicillin and tobramycin administered by hypodermoclysis in young and older healthy volunteers. Br J Clin Pharmacol. 1996 Sep;42(3):325-31. doi: 10.1046/j.1365-2125.1996.03967.x.
Results Reference
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Direct Antibiotic Delivery of Cefazolin Into Soft Tissue Infections Using Subcutaneous Injection and Ultrasonic Dispersion

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